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5.1.12 Quinolones

These are the antimicrobials used within MTW NHS Trust and West Kent CCG, please refer to the appropriate Antimicrobial guidelines for guidance on the choice of antimicrobial for different indications.

Ciprofloxacin and levofloxacin are restricted antibiotics within the Trust; they are only available for use on the advice of a consultant microbiologist EXCEPT for prophylaxis prior to ERCP and meningitis contacts.

Specialist use

x

Ciprofloxacin

Tablets 250mg, 500mg Suspension 250mg/5ml

x

x

Levofloxacin

Tablets - 250mg, 500mg

Hospital only

Ciprofloxacin

Intravenous infusion 2mg/ml

xx

Levofloxacin

Intravenous infusion 5mg/ml

The CSM advises that quinolones may give rise to tendon damage, the risk of use of which is increased with the concomitant use of corticosteroids. At the first sign of pain or inflammation, the drug should be discontinued.

Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects seeDrug Safety Update March 2019

Prescribing notes

Quinolones should be avoided in MRSA infections.

Drug interactions: as enzyme inhibitors, quinolones can cause several significant drug interactions including theophylline. Concomitant use of theophylline and ciprofloxacin is not recommended. See BNF Appendix 1 for details of drug interactions with quinolones.

Cautions: in patients with a history of epilepsy and as quinolones may induce convulsions in patients witt or without a history of convulsions. The concurrent use of NSAIDs may increase the risk.

Quinolones should be used with caution in individuals with G6PD deficiency.

Ciprofloxacin has good activity against Gram-negative bacteria including Pseudomonas and moderate activity against Gram-positives such as Streptococcus and Enterococcus. It has no anaerobic activity.

Bioavailability: Studies have demonstrated high bioavailability (60-80%) of orally administered ciprofloxacin tablets, with the time to peak concentration after an oral dose being 1-2 hours.

Administration route: oral ciprofloxacin is so well absorbed that a 500mg dose rapidly produces similar blood levels as a 400mg IV dose. It is also well tolerated and achieves excellent minimum inhibitory concentrations and has been shown to be effective in a wide range of infections. IV ciprofloxacin is restricted to situations where the oral route is NOT an option.

Levofloxacin has both Gram-negative and Gram-positive activity with greater activity against Pneumococcus than ciprofloxacin.

On this website you will now see four icons for these resources rather than two. Please use BNF Legacy or BNF for Children Legacy as these will take you to the original format of the online publications which do not have any errors or omissions.